Helping Your Anxious Child Overcome Sleep Problems

Helping Your Anxious Child Overcome Sleep Problems

As a therapist working with children and teens, I have often seen young people paralyzed by fears, worries, and anxieties. They often experience insomnia as well. It is as if they cannot get a break from the consequences of anxiety. The National Sleep Foundation recommends that adolescents get 8-10 hours of sleep per night. Numerous teens are not able to get even 8 hours of sleep per night due to demands related to academics, extracurricular activities, and friends. For adolescents with anxiety, getting adequate sleep is even more challenging. When they do not get restful and satisfying sleep (e.g., difficulties falling asleep, staying asleep, and/or waking early), they are more likely to have anxiety and general emotional distress the next day. Then, they still have high anxiety, cannot turn their brain off, and might have more sleep problems the following night. A vicious cycle! Some researchers suggest that targeting insomnia as a part of treatment for anxiety can be helpful, not only for sleep but for anxiety as well.

In a great article by Mullin and Simon (2017), key ingredients to managing insomnia among adolescents and especially those with anxiety are provided. Talk with your child’s therapist about using these great strategies! The researchers said that interventions for anxiety should include the following:

Exposure: Gradually expose youth to anxiety-provoking situations and give them the tools to conquer, overcome, and master those situations!Coping Thoughts: Avoid those thinking traps that lead to anxiety! Help them to think in ways that will decrease anxious feelings (Example “I’ve been in that situation before, and I survived, even if I didn’t like it so much, I survived – so I can do it again.”)Relaxation: Anxiety can lead to muscle tension, stomachaches, tingling sensations, and other physical symptoms. Belly breathing, imagery, meditation, and muscle relaxation are all great tools!Education: Talk with your child’s therapist about anxiety and its consequences.Modeling: Create opportunities for your child to see how anxiety can be overcome through the consistent use of strategies taught in therapy.

The techniques mentioned above might indirectly assist with sleep, but do not explicitly target sleep. Mullin and Simon (2017) presented an overview for Cognitive-Behavioral Therapy (CBT) for insomnia (CBT-I). If your child has significant sleep problems, talking with his/her therapist about these components could be helpful.

Component #1: Sleep Assessment
Sleep diary that tracks the time he/she attempted to go to bed, the actual time of falling asleep, number of times he/she woke up during the night, morning wake time, and morning and evening anxiety symptoms. This information will help your child’s therapist with important next steps in treatment.

Component #2: Sleep Hygiene
Helpful for sleep – daytime exercise and physical activity; consistent sleep schedule; a sleep space that is quiet, dark, and cool; wind-down time at night (e.g., read, listen to music, draw, and other relaxing behaviors consistent with the adolescent’s interests); stop use of electronics at least one hour before bedtime
Unhelpful for sleep – caffeine consumption; exercise within 2 hours of bedtime; naps; cluttered or uncomfortable sleep space; sleeping in the same room with parents or siblings to cope with anxiety

Component #3: Stimulus Control
Use the bed and bedroom for sleep only. Do homework, watch TV, use electronic devices, eat, and read in another area of the home. Create another comfortable, quiet, and somewhat private space in which teens can engage in these activities. If another space is not available, create an area in their bedroom that is not the bed.

Component #4: Sleep Restriction (Due to the challenging nature of this component, this may not be as necessary for clients with less chronic or severe insomnia)
Set a consistent bedtime and wake time. It is very important to keep these times consistent! Problem-solve regarding activities to engage in to stay awake until bedtime. No naps. CAUTION: Teens might have increased daytime sleepiness during this portion of treatment. Determine the degree to which this is acceptable. The teen should not drive during this portion of treatment. The authors provide an additional caution for teens with or at risk for Bipolar Disorder as sleep deprivation has been found to lead to manic episodes in some individuals with Bipolar Disorder.

Component #5: Cognitive Restructuring
Healthy and accurate beliefs about sleep. Identify multiple topics to think about at bedtime or when he/she wakes during the night that does not arouse him/her but keep his/her attention such as a TV show, movie, etc. Relaxation techniques can also be helpful.

The Society of Behavioral Sleep Medicine (www.behavioralsleep.org) is an excellent resource.

We wish you and your family the best as you continue to unlock your child’s full potential!!

Khiela J. Holmes, PhD is a Licensed Clinical Psychologist at Arkansas Families First. Dr. Holmes provides therapy and assessment services to individuals ages 6 to 25 with symptoms related to trauma, anxiety, depression, ADHD, behavior, and Autism. She is also an Academic Faculty Visitor in the College of Public Health at the University of Arkansas for Medical Sciences. Her primary research interests include cultural variables, aggression and disruptive behaviors, and the intersection of mental health and faith. She is available for training, workshops, and speaking engagements.

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